December 16, 2002
For many years, particularly in the 1980s when people first heard about AIDS, it was seen as a gay male disease. As a result, some HIV positive women may not have been aware of their infection until serious symptoms appeared and their disease had progressed. Moreover, this stereotype of who-gets-AIDS may have influenced decision-making by some doctors who treat women, who may have been reluctant to test their female patients for HIV. This, along with many other factors -- including the lack of social networks for HIV-positive women in the early years of the epidemic, women's role as caregivers, their lower socioeconomic status and partner violence -- may have contributed to reduced survival for HIV positive women compared to their male counterparts.
Researchers in Italy and the U.K. have been monitoring the health of a large number of HIV positive men and women for several years. They analysed information in their database to compare differences between men and women in the following areas:
Between 1996 and February 2001, researchers recruited 3,658 HIV positive subjects (37% women, 63% men) who had the following profile at the start of the study:
Researchers found that the following proportion of subjects began therapy once they entered the study:
The researchers grouped together men and women who entered the study at roughly the same time. In general, they found that despite entering the study at the same time, men began therapy about three months earlier than women did.
However, when researchers analysed the data, they noticed that even though, on average, men began therapy earlier than women, both sexes began therapy at the appropriate time for their health care needs -- when taking into account CD4 counts and viral loads. This suggests that doctors were applying treatment guidelines equally to both sexes, at least when it came to the timing of therapy.
The researchers also looked at the complexity of combination therapy which people with HIV/AIDS used initially. They found the following:
Why some women were offered less complex regimens was not clear.
The researchers looked at the data about stopping therapy. Specifically, they were interested in PHAs who stopped taking their medications for three or more months. In this analysis, they found the following:
A total of 147 subjects developed infections and/or cancers while in the study. There were a total of 43 deaths, nine of which were not related to HIV (for example, accidents). There were no major differences between men and women in the development of AIDS-related complications or deaths.
This study is interesting but the findings raise some questions such as:
We hope that the research team seizes the opportunity to answer these and other important questions relating to the care and treatment of both men and women with HIV.